Saturday, November 19, 2011

St. Elsewhere

While in my residency, I did an anesthesia rotation at Charity Hospital in New Orleans.  As Pediatric Dentistry residents, we spent every day for a month providing anesthesia for all kinds of surgical cases.  Later on, we did a rotation at Children's Hospital.  During these rotations, with often minimal supervision, we started IVs, calculated and administered medications, intubated the patients and provided whatever was needed to keep the patient asleep and alive during surgery.

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It could be stressful, as we were no as familiar with the OR as the medical residents.  Moreover, Charity was a unique place.  It was built like Fort Knox with 24 operating rooms on the 12th floor.  It was an old building and had an eerie St. Elsewhere atmosphere.  In fact, it seemed every time I entered the building, I'd hear the theme song from that TV show.  We didn't get too much help from anyone there and kind of had to fend for ourselves, scrounging up supplies.  If you didn't have an IV setup or a pulse oximeter, you'd just "steal" one from an adjacent unoccupied operating room before someone was the wiser.  We also sat in on anesthesia resident meetings.  Some of the surgeries were interesting to watch.  Of course, we were actually quite busy keeping the patient monitored.  There were orthopedic cases and a few jaw reconstructions, sometimes abdominal surgeries, but mostly minor stuff.

Every now and then they brought in patients from the local prisons for treatment.  One day one of them escaped and somehow in the ensuing melee, was chased outside, where the police promptly shot him.  They brought him right back in the hospital to get patched up and go back to jail.  That was a typical day at Charity.  Of course Charity became even more infamous during hurricane Katrina.  I was so glad to finish with the rotation, but was thankful to have had the experience.  I learned a lot about sedation and anesthesia.


18 comments:

swiss life said...

very interesting

Anonymous said...

hi, i am 22 yr old male.Recently i met a dentist and took the x-ray of my mouth which stated that i have 5 extra teeth 4 of them are ejecting from the jaws i.e., one on the lower side of my right jaw,same on the left side .and an another teeth on the right side upper jaw which is ejecting just fro the already existing teeth due to which i am experiencing pain.can u please suggest me a solution how to deal this problem..

Bellaire Dentist said...

It is very glad to know that even in challenging situation brave efforts make a god result.

Dr. Dean Brandon said...

Extra, or supernumerary teeth are not that uncommon. I would have your dentist do a complete evaluation. It is possible that a recommendation to remove the extra or impacted teeth would be made. Usually an oral surgeon would be consulted at some point as well. Some situations are more complicated than others. Good Luck.

Dental Services Florida said...

it is a great resource thanks for share

Chance said...

Any advice on doing a crown versus ped partial on a front (next to the front) tooth? There's about 1/8 inch left on the broken tooth if we do the crown. Have to decide soon, appointment in the morning (in Madison, Wi.) THANKS! I've been reading your old posts on both and just don't know!

Dr. Dean Brandon said...

1/8 inch does not sound like much to hang on to. Still partials are a hassle especially just one tooth. It's a judgement call. Good luck.

Chance said...

I really appreciate your response! I guess it just seems like a lot for a 3 year old to get a root canal and crown, for it to possibly fall off since the baby tooth is so tiny. Then to just get it pulled anyway.

I can't find information on why pulling a baby tooth is bad? And why is a partial a hassle?

Your blog is great, thanks again, I'm looking forward to your response!

Dr. Dean Brandon said...

There is usually nothin wrong with removing the tooth and not Placing a partial. See my post on partials. There is no need for a front baby tooth partial other than looks. Well have to go see patients here.

Chance said...

Thanks, I really wish you were our dentist! Your patients are lucky to have you. By the way, I'm leaning towards tooth abstraction and then getting the pedo partial (maybe we just won't use it, although the dentist here thinks it's necessary for space management even though my son's teeth are well space, no crowding). Thanks again!

Chance said...

We ended up doing the extraction and no partial. It's fine to have a space and thing there will be less hassle (compared to having a partial in) and I wasn't told of any diet restrictions.
I'm a speech therapist and know that sound development won't be affected by this one missing tooth.
My son (3.5 years) did horrible with the versed and vistaril. He barely made it through the removal. They had to give him the drug to reverse it. The dr. said he had a vagal response and my son nearly fainted twice. It seemed like a simple procedure but turned out to take 3 hours. Oh well. He seems to be doing well now and I know that's what matters.
Thanks again. I would not have known that an empty spot was ok if it weren't for your blog, it prompted me to ask my dentist who didn't offer this option.

Anonymous said...

Hi, just looking for advice. My 7 year old went to have at least 6 teeth removed 2 days ago but refused the cream to numb his hand and spat out the "juice". The hospital sent him home and said they will send out an appointment to go visit the hospital to try and get him used to it. I don't think he'll ever co-operate, is there anything else that can be done, he's so bad that he refused an xray so there will be more than 6 to come out. I'm worried about how long the process will take and he will be in pain.

Dr. Dean Brandon said...

I know that when we are at the hospital, we are doing general anesthesia cases and even disruptive kids they are able to get asleep with medications and anesthesia gas. The only reason they send them home is if they have had something to eat (they are supposed to have an empty stomach) or some other health problem. Sounds like you were in, not for general anesthesia but conscious sedation. If that is the case, yes, it is difficult to get a resistant anxious child to drink any sedative meds and they sometimes spit it out. Sometimes it is worth trying again, but if it's just removal of teeth, perhaps general anesthesia or even an oral surgeon can be consulted. They can place the child asleep sometimes in their office under controlled circumstances. Often we have to have the patients all the way asleep for treatment. I have seen them put a child asleep in 15 seconds with anesthesia gas in the operating room. Then all treatment can be accomplished. Read my posts on sedation and hospital dentistry.

Dr. Dean Brandon said...

Oh, with disruptive kids (say a two year old who cannot be expected to cooperate even in the best of circumstances) they put them asleep first with gas, then start an IV after that.

Anonymous said...

He was to be put to sleep but they were having to sedate him first. I forgot to say I'm from the uk so I'm not sure if procedures are different although they did say its unusual not to be able to persuade a child, he is petrified. We went to go in a room with a dentist chair and he ran out it took ages to persuade him that he wasn't to go on the chair. They also said gas would be a last resort as it would take a few visits to get all the work done and that would traumatise him further. The only way I can see him getting it done is if he was restrained but they no longer do that.

Megan said...

Dr. Brandon did you ever get to help sedate a person who had a brain operation. I know when I had mine done at UAB I saw about 7 to 8 Docters surrounding me i would be like were did these people come from. they were with my neoraligist and my nerosurgion I wish they did not sedate me but what I heard they did to me sounds facinateing like leaving a a piece of bone from your skull in a freezer for monthes and then going monthes later to have it put right back in like a jigsaw puzzle.

Megan said...

all though I do know the anesthesia would so make me sick when I woke up.

Dr. Dean Brandon said...

Sounds like you had some deep sedation at the hospital. That's a little different from what we do in the dental office. We did a lot of cases in the hospital especially during my anesthesia rotations. These days we see many patients with various medical conditions.